These behaviors on the part of nursing assistants cost hospitals and nursing homes large amounts of money. Moreover, they represent a very real legal liability – can the facility prove in court that it exercised due diligence to prevent misbehavior that has bad consequences for residents?

What is to be done? There are two basic approaches management can use to lessen or mitigate these problems. First, more careful selection methods should be used to assess candidates before they are hired. The best predictor of future behavior is past behavior, but misbehavers are those least likely to report their past behavior voluntarily. Thus, it is necessary to go beyond simply asking job applicants about what they have done in the past.

Second, there are management processes and procedures that can be used to minimize the opportunity for misbehavior on the job. These include, but are not limited to, careful control of access to the drug cabinet, supervision at certain times of the day, and clear policies for employees of the consequences for their misbehavior.

Let us examine selection issues first. Background screens are indispensible for proper selection, and many facilities already require them. But assessments of basic skills, personality, attitudes, values and motivation are also essential. Some of these can be assessed by well-designed interviews, but others can only be measured by psychological testing.

Realistic job previews may also be helpful in weeding out those who are not temperamentally suited to the job. While there is some basic nursing knowledge that nursing assistants must have, it is generally not lack of knowledge that causes them to misbehave on the job. Administrators may object, saying that such selection procedures are tedious and time consuming, but proper due diligence in selection is well worth the time and effort.

With regard to management of misbehavior once the nursing assistant is on the job, there is no substitute for effective training. The basic values and expectations of the facility should be communicated to candidates from the very first encounter. All recruiting literature should feature values and norms of the facility prominently. Orientation training should reiterate these norms and values.

A session on expectations and disciplinary procedures should be included in the early training of the new hire. Management should maintain a zero tolerance policy for drug and alcohol abuse, physical or verbal abuse, and sexual harassment. Cases of these violations that occur should be made public, and the discipline outlined in the training manuals should be followed carefully and as publicly as possible. Supervisors should know that when they report misbehavior that they are just doing their job.

Misbehavior by nursing assistants can have catastrophic consequences for any nursing facility. It is important that management be able to show that they have exercised every possible precaution to prevent such things from happening. While such precautions do not guarantee that misbehavior will not happen, they will limit its frequency, severity and legal consequences. An ounce of prevention is always worth a pound of cure.

To learn more about setting up effective hiring processes and orientation training to prevent nursing assistant misbehaviors, please contact Kevin von der Lippe at (919) 878-9222, (336) 899-1150 or kevin.vonderlippe@capital.org. In addition to the special assessment tools for screening Certified Nursing Assistants (CNAs), Kevin will be happy to talk to you about CAI’s background checking services.

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